High Negative Predictive Value of Normal Body Mass Index for Obstructive Sleep Apnea in the Lateral Sleeping Position

J Clin Sleep Med. 2018 Jun 15;14(6):985-990. doi: 10.5664/jcsm.7166.


Study objectives: Obesity is a major risk factor for obstructive sleep apnea (OSA). Patients who are not obese and who have OSA usually present with a low apnea-hypopnea index (AHI) in the lateral sleeping position. Hence, sleep-disordered breathing (SDB) seems more dependent on body mass index (BMI) in the lateral sleeping position than the supine sleep position. This makes obesity a better predictor of SDB in the lateral sleeping position. The objective of this study was to find a negative predictive value of normal BMI for SDB in relation to sleep positions, thus defining a group of patients who could be treated by positional intervention, and prioritizing the use of polysomnography diagnostics.

Methods: This study comprises a retrospective and prospective part run on groups of 1,181 and 821 consecutive patients, respectively. All had been referred to the university-based sleep laboratory because of suspected OSA and underwent polysomnography.

Results: In the retrospective study, areas under the receiver operating characteristic curves for normal BMI at AHI ≥ 5 and AHI ≥ 15 events/h were found to be larger in the lateral sleeping positing than supine: 0.79 versus 0.69 and 0.80 versus 0.68, respectively (P < .05). Comparable results were obtained in the prospective study. For normal BMI, the negative predictive value for AHI < 15 events/h in the lateral sleep position was 97.5% and 97.1% in the retrospective and prospective study, respectively.

Conclusions: Normal BMI offers a high negative predictive value for moderate or severe OSA in the lateral sleeping position.

Keywords: BMI; polysomnography; positional obstructive sleep apnea; predictive values.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Posture / physiology*
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / physiopathology*